Integration of Chemotherapy with Brachytherapy in the Treatment of Locally Advanced Uterine Cervical Cancer
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Standard treatment regimen for locally advanced inoperable cervical cancer has remained external beam radiation with concurrent chemotherapy followed by brachytherapy. However, the persistent/recurrent pelvic disease remains a significant obstacle in curative intent and prolonged survival. According to recent published literature, approximately half of locally advanced disease of cervix fails in treated pelvic area. The success of treatment depends on a careful balance between external beam radiotherapy (EBRT) and brachytherapy that optimizes the dose to tumor and normal tissues and the overall duration of treatment. The addition of brachytherapy serves to boost the gross tumor, and improves disease control and survival. Cure is interlinked with radiation dose escalation however such ingredients to improve local control by increasing radiation dose is hampered by the limited tolerance of surrounding critical organs like bladder, rectum and intestines. Therefore, attempts have been made to improve the local control and survival in the advanced stages of the disease by combination of radio-sensitizers like cisplatin with external beam radiation. Several authors have claimed overall improvement of disease-free survival as compared to treatment with radiation alone. Role of concurrent chemotherapy with EBRT is well understood but data for effect of concurrent chemotherapy with brachytherapy is limited.